Safety Week guest column: A primer in transferring patients

The following is an excerpt of a guest column by Bruce Cunha, RN, MS, COHNS, manager of employee health safety, Marshfield Clinic, Marshfield, WI.

The current obesity issues we are seeing in the general population also means that we are seeing heavier patients in our hospitals and clinics.

If someone asked you what patient transfer activities have the greatest potential for causing an injury to a health care worker, you would probably tell them moving a patient from a bed to a gurney or a procedure table. Or perhaps you would tell them repositioning a patient in a bed, or assisting a patient from sitting to standing.

How many of us would include things like pushing a patient in a wheelchair or pushing a gurney? While these activities may not come to mind as a major cause of injury to healthcare workers, the fact is that pushing patients is one of the more common causes of injuries for healthcare workers.

Have you considered the amount of force it takes to move a patient in a wheelchair, gurney or hospital bed prior to moving that patient? Do you consider that you may need assistance in pushing a patient? Most of us would balk if we were asked to push a 400-pound block of concrete across the floor, but what if that 400 pounds was in a wheelchair or in a hospital bed?

Healthcare has a variety of patient handling systems that can be used for lifting, repositioning, sit to stand, and transfers from one surface to another. Currently, mechanical systems built to push are not as prevalent.

Some manufacturers are producing hospital beds and gurneys that have power wheels. Other companies are producing motorized systems that can hook on to a wheelchair and push the chair. These systems may not work on all wheelchairs or on some of the larger bariatric wheelchairs.

Other manufacturers produce assistant-driven chairs (motor and steering controls are at the back of the chair so an assistant can operate the chair).

As with other transfer equipment, these devices have weigh limits and finding mechanical equipment that goes above 700 pounds limits the choices significantly.

Cost is always an issue that comes up when looking at safety equipment. Costs increase as the amount of weight a device can hold and the size of the device gets larger. A standard wheelchair that can hold up to 300 pounds can run $150 to $300. A wider wheelchair with a 600-pound capacity can run $750 to $1,500 or more. Increase that capacity to 750 to 1,000 pounds and the prices go from $1,500 to $3,000.

The overriding issue is that no one person should be pushing much more than 300 pounds. So when you move up to a chair that can handle 600 pounds, you should be looking at powered chairs. Powered chairs that can be operated by an attendant can run $1,900 to $4,000 for a chair that can handle 600 pounds. Move to 850 pounds and the costs moves to around $8,000 dollars. If you need a powered chair that can hold 1,000 pounds, you are looking at costs of $16,000 to $18,000 dollars.

While the above costs seem like a lot, they have to be compared to what an injury costs. Injuries from pushing heavy patients typically involve knees, shoulders and backs. The cost of a knee injury that requires an arthroscopy can run $20,000 or more when you include an MRI, physical therapy, surgery, and time off for recovery. A shoulder surgery can cost $20,000 to $50,000 depending on if it is arthroscopic or open surgery. A back injury can run $5,000 for a strain that requires an MRI, and physical therapy to $50,000 or more if surgery is needed. Add in time off and disability and that can move up towards $100,000. These are for single injuries.

In conclusion, injuries related to handling patients are not just limited to lifting. How we move a patient around our facilities should be included in your patient-handling safety protocol. Facilities need to address how they will handle larger patients and should have a plan in place for dealing with very heavy patients.